Predictors of highly prevalent brain ischemia in intracerebral hemorrhage

Ravi S. Menon, Richard E. Burgess, Jeffrey J. Wing, M. Christopher Gibbons, Nawar M. Shara, Stephen Fernandez, Annapurni Jayam-Trouth, Laura German, Ian Sobotka, Dorothy Edwards, Stella Kidwell

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Abstract

Objective: This study was undertaken to determine the prevalence, characteristics, risk factors, and temporal profile of concurrent ischemic lesions in patients with acute primary intracerebral hemorrhage (ICH). Methods: Patients were recruited within a prospective, longitudinal, magnetic resonance imaging (MRI)-based study of primary ICH. Clinical, demographic, and MRI data were collected on all subjects at baseline and 1 month. Results: Of the 138 patients enrolled, mean age was 59 years, 54% were male, 73% were black, and 84% had a history of hypertension. At baseline, ischemic lesions on diffusion-weighted imaging (DWI) were found in 35% of patients. At 1 month, lesions were present in 27%, and of these lesions, 83% were new and not present at baseline. ICH volume (p = 0.025), intraventricular hemorrhage (p = 0.019), presence of microbleeds (p = 0.024), and large, early reductions in mean arterial pressure (p = 0.003) were independent predictors of baseline DWI lesions. A multivariate logistical model predicting the presence of 1-month DWI lesions included history of any prior stroke (p = 0.012), presence of 1 or more microbleeds (p = 0.04), black race (p = 0.641), and presence of a DWI lesion at baseline (p = 0.007). Interpretation: This study demonstrates that >1/3 of patients with primary ICH have active cerebral ischemia at baseline remote from the index hematoma, and 1/4 of patients experience ongoing, acute ischemic events at 1 month. Multivariate analyses implicate blood pressure reductions in the setting of an active vasculopathy as a potential underlying mechanism. Further studies are needed to determine the impact of these lesions on outcome and optimal management strategies to arrest vascular damage.

Original languageEnglish (US)
Pages (from-to)199-205
Number of pages7
JournalAnnals of Neurology
Volume71
Issue number2
DOIs
Publication statusPublished - Feb 2012
Externally publishedYes

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ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Menon, R. S., Burgess, R. E., Wing, J. J., Gibbons, M. C., Shara, N. M., Fernandez, S., ... Kidwell, S. (2012). Predictors of highly prevalent brain ischemia in intracerebral hemorrhage. Annals of Neurology, 71(2), 199-205. https://doi.org/10.1002/ana.22668